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We Need Palliative Care
Everywhere
SMACC DUB 2016
Ashley Shreves, MD
Dept of Emergency Medicine
Ochsner Medical Center
New Orleans, LA
Case
• 2009
• EMS: 93 y/o f, resp distress
• HR 25, BP 90/50, O2 sat 90%, RR 35
0920 0945 shreves
What happened next...
Specific challenges
• Identify dying trajectory
• Capacity assessment
• Advance directives
• Difficult communication
• Withholding/withdrawing LST
• EOL symptom management
• Spiritual competency
• Ethics
• Systems of care
Maybe it’s just me
Conversations bad, brief or nonexistant
Dying patients “neglected;” staff
uncomfortable
Dying in hospital:
less respect, quality of care worse
WE ALL SUCK AT THIS
Relevant to you?
Canada: 1/3 cancer patients visit ED last 2
wks of life
Australia: 65% patients w serious illness
die in hospital/ED
WE ALL SEE THESE PATIENTS
WHAT SHOULD WE DO?
Consult Palliative Care?
• Sure, but…
• 67% US hospitals (50+ beds) have pal care
• Workforce shortage: have 3K, need 18K (just in hospital)
• There will never be enough
Lupe D et al. J Pain Symptom Manage 2010
Dumanovsky T et al. J Palliate Med 2016
Kamal AH et al. Ann Intern Med 2015
Solution?
0920 0945 shreves
Fellowship
Mid-career courses
Online resources
We need palliative care everywhere

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